Provider Demographics
NPI:1306219928
Name:VELASQUEZ, VELIA
Entity Type:Individual
Prefix:
First Name:VELIA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:ID
Mailing Address - Zip Code:83210-0204
Mailing Address - Country:US
Mailing Address - Phone:208-220-5044
Mailing Address - Fax:
Practice Address - Street 1:365 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:ID
Practice Address - Zip Code:83210-0204
Practice Address - Country:US
Practice Address - Phone:208-220-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide